Intimacy as a determinant of expressed emotion in carers of people with Alzheimer's disease

Background. Although high expressed emotion (EE) has been found to be an important predictor of poor prognosis in a wide range of conditions such as schizophrenia, anorexia and depression no complete explanation exists for individual differences in EE responses The aim of this paper is to investigate the role of intimacy in determining the level of EE in carers of people with dementia. Methods, Ninety-nine carers of people with dementia who presented to Old Age Psychiatry Services in South and Central Manchester completed questionnaires to ascertain past and current levels of intimacy. Camberwell Family Interviews (CFIs) were carried out to ascertain levels of EE. Results, Current intimacy was found to be strongly related to EE such that low current intimacy was associated With high EE and there was a significant difference between high and low intimacy groups on measures of criticism and hostility, though not warmth. Conclusions. The association found between intimacy and EE indicates that high EE may be a characteristic of low intimacy relationships between the carer and the cared-for-person. Since the assessment of EE is time intensive, perhaps a measure of intimacy will provide a short-hand screen for identifying critical and hostile caring environments.